Use Of Antimicrobials For Treatment Research Articles

Ochrobactrum anthropi infection following corneal transplantation -a case report and review of literature

BackgroundOchrobactrum anthropi is widely distributed and primarily infects patients with compromised immune functions . Historically, O. anthropi has been considered to possess low toxicity and pathogenicity; however, recent studies suggest that it may in fact cause severe purulent infections. In this case study, we examine a case of O. anthropi infection following corneal transplantation, exploring the occurrence and outcomes of such post-operative infections.Case presentationA retrospective analysis of cases involved examinations, genetic testing for diagnosis, and subsequent treatment. In patients undergoing partial penetrating keratoplasty with a fungal corneal ulcer perforation, anterior chamber exudation and purulence were observed post-surgery. Despite antifungal treatment, genetic testing of the anterior chamber fluid and purulent material confirmed O. anthropi infection. The use of antimicrobial treatment specifically targeting O. anthropi was found to be effective in treating the infection.ConclusionInflammatory reactions following corneal transplantation should be should be monitored for the presence of other infections. Genetic testing has significant implications for clinical diagnosis and treatment.

KNOWLEDGE AND ATTITUDE OF FARMERS TOWARDS ANTIMICROBIAL RESISTANCE IN ASIA: A SYSTEMATIC REVIEW AND META-ANALYSIS

Background: Antimicrobial resistance is a severe threat to public and environmental health. The agricultural sector contributes significantly to resistance, where antimicrobials are used as prophylaxis, growth promoters, and for treatment. A series of studies have been conducted to assess farmers' knowledge and attitude levels with varying results, particularly in Asia, one of the world's largest producers of livestock products. Purpose: To review the pooled estimated level of knowledge and attitude towards antimicrobial use and resistance in Asia. Methods: A literature search was conducted according to PRISMA in Scopus, PubMed, Google Scholar, and Embase for studies up to 30 April 2023. Quality was assessed using the Newcastle-Ottawa Scale (NOS) for cross-sectional studies. Outcomes were further categorized into constructs under knowledge and attitude. Random-effect meta-analysis was conducted using STATA 17. Results: 11 studies and 2131 subjects were included with fair to excellent quality. From the meta-analysis, the following knowledge and attitude levels were estimated: definition [55.7% (95%CI: 37.3%-74%)] and cause [60.6% (95%CI: 40.5%-80.6%)] of antimicrobial resistance; the negative impact of antimicrobials [62.6% (95%CI: 16.9%-100.0%)]; use of antimicrobials for treatment [47.8% (95%CI: 6.1%-89. 4%)], prophylaxis [58.5% (95%CI: 28.5%-88.5%)], growth promoter [39% (95%CI: 23.1%-54.9%)]; discontinuation of antimicrobials upon improving conditions [42.5% (95%CI: 15.4%-69.5%)]. Conclusions: Farmers in Asia have moderate knowledge of antimicrobial resistance but still exhibit attitudes that support resistance.

Infection Control Challenges and Solutions in Long-Term Care Facilities

In long-term care facilities, it is crucial to address infection control challenges to safeguard the health and well-being of residents, especially considering the characteristics of elderly individuals and those with chronic illnesses. This review discusses clinical management strategies that stress the importance of measures, early identification of residents at risk, and prudent use of antimicrobial treatment. The collaboration among healthcare professionals from fields like physicians, nurses, pharmacists, and infection prevention experts is seen as an element for effective clinical management. The importance of tools, the use of antimicrobials, and the incorporation of technology are emphasized to improve overall infection management in long-term care facilities. The discussion also stresses the need to tailor approaches to types of infections such as respiratory issues, gastrointestinal problems, and skin infections. Environmental adjustments, continuous monitoring efforts, and initiatives for quality enhancement are highlighted as steps to tackle the clinical manifestations observed. Overall, the review underscores the necessity for a personalized approach toward infection control within long-term care settings. By implementing strategies fostering teamwork across disciplines and tackling the specific obstacles presented by clinical symptoms, these facilities can enhance the well-being of residents and establish a safer healthcare setting.

The ingredients for an antimicrobial mathematical modelling broth

Mathematical modelling has made significant contributions to the optimization of the use of antimicrobial treatments. This article discusses the key processes that such mathematical modelling should attempt to capture. In particular, this article highlights that the response of the host immune system requires quantification, and this is illustrated with a novel model structure.

Investigation of antimicrobial susceptibility and virulence factor genes in Trueperella pyogenes isolated from clinical mastitis cases of dairy cows.

Trueperella pyogenes is an opportunistic pathogen causing important diseases including mastitis and metritis in domestic animals such as dairy cows leading to prominent economic losses in food production industry. The aim of this study was to investigate bacterial species, antimicrobial susceptibility, and presence of virulence factor genes and genotyping of T. pyogenes isolates associated with summer mastitis cases from 22 different farms around Tehran, Iran. Fifty‐five percent of dairy cows with clinical mastitis symptoms was infected by T. pyogenesis indicated that this pathogen is the most important contributor to clinical mastitis in dairy cows in the present study. A significant correlation was illustrated between presence of virulence factor genes of isolated pathogen, biochemical patterns, and the utter infected types. Multidrug resistance susceptibility observed between isolates indicated the important need for prudent use of antimicrobials in treatment of mastitis caused by T. pyogenes and increased concerning of consumer health associated with recent problems of antimicrobial resistance. The categorization of isolates was implemented into seven different clonal related types by COX‐PCR at 80% of similarity cutoff with significance relationship to clonal types, CAMP test result and sampling time and biochemical profile. Regarding to the results obtained at the present study, T. pyogenes can be considered as an important typically cause of purulent and acute form of clinical bovine mastitis and loss of dairy productivity. Further studies with more sample size and high‐throughput omic methods in various sampling time and areas are suggested for study of this pathogen precisely.

Controlled release of iodine from cross-linked cyclodextrin metal-organic frameworks for prolonged periodontal pocket therapy

Effective therapeutic system to periodontitis was designed using cross-linked cyclodextrin metal-organic framework (COF) as carrier for iodine and further suspended in hydroxyethyl cellulose gel as I2@COF-HEC hydrogel. Inclusion of iodine within the COF was demonstrated by SR-FTIR spectral and characteristic DSC and TGA changes. Molecular modelling identified the interaction of iodine with both COF central cavity and individual cyclodextrin moieties of COF. In vitro results of study demonstrated that iodine release in artificial saliva from I2@COF-HEC hydrogel could be extended up to 5 days, which was slower than I2@COF particles. Using an in vivo rat model of periodontitis, micro-computed tomography of alveolar bone morphology demonstrated that I2@COF-HEC hydrogel showed similar effects in decreasing periodontal pocket depth and alveolar bone resorption to minocycline ointment, a periodontitis antibiotic. The I2@COF-HEC hydrogel is a novel local delivery device of iodine as a broad spectrum antimicrobial use for treatment of periodontitis.

Infective endocarditis in paediatric population.

Infective endocarditis is very uncommon in children; however, when it does arise, it can lead to severe consequences. The biggest risk factor for paediatric infective endocarditis today is underlying congenital heart defects. The most common causative organisms are Staphylococcus aureus and the viridans group of streptococci. The spectrum of symptoms varies widely in children and this produces difficulty in the diagnosis of infective endocarditis. Infective endocarditis in children is reliant on the modified Duke criteria. The use of blood cultures remains the most effective microbiological test for pathogen identification. However, in blood culture-negative infective endocarditis, serology testing and IgG titres are more effective for diagnosis. Imaging techniques used include echocardiograms, computed tomography and positron emission tomography. Biomarkers utilised in diagnosis are C-reactive protein, with recent literature reviewing the use of interleukin-15 and C-C motif chemokine ligand for reliable risk prediction. The American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines have been compared to describe the differences in the approach to infective endocarditis in children. Medical intervention involves the use of antimicrobial treatment and surgical interventions include the repair and replacement of cardiac valves. Quality of life is highly likely to improve from surgical intervention.Conclusion: Over the past decades, there have been great advancements in clinical practice to improve outcomes in patients with infective endocarditis. Nonetheless, further work is required to better investigative and manage such high risk cohort. What is Known: • The current diagnostic techniques including 'Duke's criteria' for paediatric infective endocarditis diagnosis • The current management guidelines utilised for paediatric infective endocarditis What is New: • The long-term outcomes of patients that underwent medical and surgical intervention • The quality of life of paediatric patients that underwent medical and surgical intervention.

Efficacy of a coordinated strategy for containment of multidrug-resistant Gram-negative bacteria carriage in a Neonatal Intensive Care Unit in the context of an active surveillance program

BackgroundAntimicrobial resistance in neonatal intensive care unit (NICU) patients is a threat, due to the frequent use of antimicrobial treatment and invasive devices in fragile babies. Since 2014 an active surveillance program of multidrug-resistant Gram-negative bacteria (MDR-GNB) carriage has been in place in the five NICUs of Palermo, Italy. In 2017 an increase in the prevalence of MDR-GNB, and in particular of extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-KP), was observed in “Civico” hospital NICU.AimTo assess the impact of a coordinated intervention strategy in achieving long-lasting reduction of MDR-GNB prevalence in the NICU.MethodsRectal swabs were obtained monthly and processed to detect MDR-GNB using standard methods. MDR-GNB were characterized by pulsed-field gel electrophoresis (PFGE). Since November 2017 the following intervention measures were applied: (a) two-months intensification of sample collection; (b) stakeholders meetings; (c) improvement of prevention measures and antimicrobial policies.FindingsDuring the intensified microbiological surveillance MDR-GNB and ESBL-KP were detected in rectal swabs (34.8%; 23.2%), nasal swabs (24.6%; 14.5%), oral swabs (14.5%; 5.4%), milk samples (32.1%; 17.9%), pacifiers swabs (30.8%; 17.9%) and from sub-intensive room surfaces. Thirteen ESBL-KP strains isolated from clinical and environmental samples showed identical PFGE patterns. The prevalence of MDR-GNB and ESBL-KP carriage significantly decreased in the year after intervention compared to the previous year (20.6% vs 62.2%; p < 0.001 and 11.1% vs 57.8%; p < 0.001). MDR-GNB were not detected at all for three months and ESBL-KP for five months. Multivariate analysis of the principal exposure variables showed that admission in the post-intervention period significantly reduced the risk of MDR-GNB carriage (adj-OR = 0.21, 95% CI = 0.076–0.629; p < 0.001).ConclusionsMDR-GNB broadly circulate in NICU setting, they can colonize different body sites and spread through various vehicles. A coordinated strategy of multiple interventions with active cooperation between epidemiologists and clinicians in the NICU can effectively reduce their circulation and in particular the carriage of the most dangerous ESBL-KP strains.

Evaluation of a rapid coliform detection kit from clinical mastitis milk using colloidal gold nanoparticle-based immunochromatographic strips.

The accurate identification of mastitis‐causing bacteria assists in effective management by both dairy farmers and veterinarians and can be used to implement the selective use of antimicrobials for treatment. The purpose of this study was to evaluate the ability of our developed anti–ribosomal protein-L7/L12 antibody–coated immunochromatographic strip (ICS) test to detect coliforms in milk by comparing the results with the bacteriological culture method. We investigated the performance of the ICS test as compared with the bacteriological culture method using 308 milk samples from clinical bovine mastitis. First, to determine the optimal ICS test cutoff point for detecting coliform mastitis, we developed a receiver-operating characteristic curve. The result showed that the cutoff point was at 0.5 of our index. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value of the ICS test were 81.3%, 84.8%, 69.2%, and 91.54%, respectively. As the clinical signs increased in severity, the F-measure, a weighted harmonic mean of the sensitivity and overall PPV performance, increased. Because it is especially important to treat clinical mastitis appropriately in the early stages of detection, the ICS test, which can be used by both dairy farmers and veterinarians on dairy farms, is considered to be a useful tool for detecting coliform mastitis, which often presents with severe signs.

Antimicrobial use practices and opinions of beef farmers in England and Wales.

Limited research exists on antimicrobial use practices of beef farmers. This study aimed to investigate antimicrobial practices and perceptions of beef farmers in England and Wales, and identify drivers of higher antimicrobial use for treatment of bovine pneumonia. A survey was sent out in 2017 to beef farmers in England and Wales who supply to two abattoirs. Descriptive statistics were used to summarise the data. A logistic regression model was built to determine factors associated with treating greater than 5 per cent of the predominant group in the herd with antimicrobials for pneumonia. There were a total of 171 useable responses. Most farmers reported using antimicrobials in less than 5 per cent of their herd for the treatment of common diseases. Most farmers (90 per cent) reported that they understood what antimicrobial resistance means, but only 55 per cent were aware of critically important antimicrobials and 9 per cent could name at least one critically important antimicrobial. Having a calf-rearing enterprise and not considering Johne's disease when buying in cattle were associated with using antimicrobials to treat pneumonia in greater than 5 per cent of the predominant group in the herd. Self-reported antimicrobial use appears to be low in beef farms. However, some gaps in understanding aspects of antimicrobial stewardship by farmers were identified.

Antimicrobial use for treatment of healthcare-associated infections and bacterial resistance in a reference neonatal unit

ObjectiveThe use of broad-spectrum antimicrobials, such as third and fourth-generation, are responsible for emergence of multidrug-resistant microorganisms in neonatal units. Furthermore, antimicrobial daily doses are not standardized in neonatology. This study aimed to investigate the association between the use of antimicrobial broad spectrum to bacterial sensitivity profile in a referral unit of neonatal progressive care. MethodsThis is a cohort study conducted in a referral neonatal progressive care unit from January 2008 to December 2016. The data of all hospitalized neonates was collected daily. The infection criteria used were the standardized national criteria, based on definitions of Center for Diseases Control and Prevention. In this study, the use of antimicrobials was evaluated as antimicrobial-day (ATM-day) and the ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was also calculated. The study was approved by the Institutional Review Board of the Universidade Federal de Minas Gerais (ETIC 312/08 e CAAE 58973616.2.0000.5149). ResultsFrom 2008 to 2016, 2751 neonates were hospitalized, corresponding to 60,656 patient-days. The ratio of multidrug-resistant microorganisms per 1000 ATM-day of broad spectrum was 1,3 in the first period and 4,3 in the second period (p=0,005). ConclusionIt was observed that use of broad-spectrum antimicrobials, especially those with coverage for Gram-negative bacteria, was associated with an increase of multidrug-resistant bacteria.

Repurposed drug candidates for antituberculosis therapy

Antibiotics have been a key part of clinical treatments for more than 70 years. Long-term use of antimicrobial treatments has led to the development of severe bacterial resistance, which has become increasingly serious due to antibiotic abuse, resulting in the treatment of bacterial infections becoming challenging. The repurposing of approved drugs presents a promising strategy to address current bottlenecks in the development of novel antibacterial agents. Drug repurposing is a cost-effective emerging strategy, which aims to treat resistant infectious diseases by identifying known drugs with predicted efficacy for diseases other than the target disease. This strategy has potential in the treatment of tuberculosis (TB), particularly drug-resistant TB. In recent years, a panel of drugs approved for clinical use or clinical trials, such as linezolid, vancomycin and celecoxib, have been found to have anti-TB activities. However, the utility of drug repurposing is limited by the number of candidate compounds and their low activities. The low activities of repurposed drugs have slowed the development of a drug-repurposing strategy for anti-TB drugs. The present review discusses progress in the discovery of new anti-TB agents through drug repurposing since 2014. We also discuss the challenges faced and analyze the innovative ways that are being used to overcome these difficulties. This review may provide a useful guide for researchers in the field of drug repurposing.

Antimicrobial use for treatment of clinical mastitis in dairy herds from Brazil and its association with herd-level descriptors

The aims of this prospective and descriptive study were to: (a) characterize treatment profile and quantify antimicrobial consumption for treatment of clinical mastitis (CM) in dairy herds of Brazil; and, (b) determine the association of antimicrobial use (AMU) for treatment of CM and herd-level descriptors, such as herd size, average milk yield, bulk milk somatic cell count (BMSCC), bulk milk total bacterial count (BMTBC), season and housing type. Data on treatment practices were obtained from 19 of 20 dairy herds selected for the study for a period of 12 months per herd. Treatment protocols were recorded in each case of CM by the farm personnel using a form that included information at the cow- and treatment-level. The frequency of antimicrobial consumption for treatment of CM was determined monthly in units of defined daily dose (DDD) and expressed as antimicrobial treatment incidence (ATI; the number of DDD per 1,000 lactating cow-days). Mixed linear regression models were used to determine the association between log-transformed ATI and herd level descriptors. The overall monthly mean ATI was 21.9 DDD per 1,000 lactating cow-days (15.4 DDD per 1,000 lactating cow-days for intramammary compounds, and 6.4 DDD per 1,000 lactating cow-days for systemically administered antimicrobials). Among intramammary drugs, aminoglycosides had the highest ATI (11.7 DDD per 1,000 lactating cow-days), followed by a treatment with a combination of tetracycline, aminoglycoside and polypeptide (10.3 DDD per 1,000 lactating cow-days). For systemically administrated antimicrobials, fluoroquinolones (6.1 DDD per 1,000 lactating cow-days), penicillin combinations (3.9 DDD per 1,000 lactating cow-days), and the combination of sulfonamide and pyrimidine (3.6 DDD per 1,000 cows per day) were the most frequently used antimicrobials. The use of combination therapy (i.e., association of intramammary and systemically administered antimicrobials) was reported for 64.3 % of treatments at the cow-level. The AMU tended to be higher in herds with highest BMSCC. In addition, a higher AMU for treatment of CM was observed during the rainy season compared to the dry season in Brazil. This seasonal effect was mostly characteristic in herds housing cows in outdoor housing systems (i.e., paddocks).

Salmonella spp. in pigs: an update on diagnostics and control

Salmonella spp. is an important topic for both human and animal health, particularly Salmonella enterica ser. Typhimurium including its monophasic strains. Salmonella is an increasing problem on pig farms and the bacteria are transmitted through breeding pyramids, and can spread rapidly due to the high number of subclinical cases. Therefore, diagnosis on farm is extremely important, ensuring sampling from all areas of the unit to gain the overall infection picture. Modern diagnostic techniques allow differentiation between field and vaccine strains which is extremely important when implementing a vaccination programme on the farm. Vaccination accompanied by hygiene and biosecurity measures make up the three pillars of Salmonella spp. control, each of which should be given equal attention. Vaccination has been shown to be very effective in reducing environmental pressure and therefore prevalence and clinical signs due to S. enterica ser. Typhimurium. Vaccination forms part of successful Salmonella spp. control, although it is important to remember that Salmonella spp. control requires a long-term approach using a combination of interventions and avoiding the long-term use of antimicrobial treatment.

Identification and molecular epidemiology of methicillin resistant Staphylococcus pseudintermedius strains isolated from canine clinical samples in Argentina

BackgroundStaphylococcus pseudintermedius is the leading cause of pyoderma in dogs and the frequent use of antimicrobial treatment is associated to the development of resistance to nearly all classes of antibiotics. Despite S. pseudintermedius significance, our understanding of the molecular mechanism of β-lactam resistance and its genetic diversity remains limited. We aimed to: i) determine the phenotypic resistance profile of methicillin resistant Staphylococcus pseudintermedius (MRSP) isolated from infected dogs in three different veterinary hospitals in Buenos Aires, Argentina; ii) identify the SCCmec elements and resistance genes; and iii) analyze the clonal relationship between isolates and in regard of dominant lineages found in the world.ResultsIn addition to the differential levels of β-lactam resistance, MRSP isolates (n = 10) showed resistance to 5–6 families of antibiotics, and were therefore categorized as multidrug-resistant. All the isolates were variant of SCCmec V homologous to S. aureus; additional SCCmecFinder analysis classified five of the genomes as SCCmec type V (5C2&5) with mecA (encodes for PBP2a), mecRI and mecI and all the genes closely related to the reference SCCmec type V S. aureus TSGH17 strain. In the remaining five strains, mecA was present, although other genes associated with SCCmec V including mecR1 and mecI were missing. PBP2a was inducible in low level resistance strains (MRSP 8151), and constitutively expressed in MRSP 8150, suggesting different mecA regulatory mechanisms. MRSP isolates showed significant genetic diversity: eight PFGE clonal types and six multilocus-sequence typing (MLST) sequence types (STs) (339, 649, 919, 920, 921 and 922), including four new STs genetically distinct from STs reported in other geographic areas. Comparative genomics and phylogenetic analyses of the MRSP showed a correlation between the genetic content and the phenotypes, and established the genetic relationship between the isolates.ConclusionsMRSP could be a threat to animal health due to it concerning level of antimicrobial resistance. Our study highlights genetic and epidemiological aspects of multidrug-resistant MRSP strains from Argentina showing high degree of correlation between the resistance genes and the phenotype of the isolates and, furthermore, they appeared evolutionary closer to major worldwide reported ST68 and ST71.

Antimicrobial stewardship programme in critical care medicine: A prospective interventional study

ObjectiveHospital antimicrobial stewardship programmes have achieved savings and a more rational use of antimicrobial treatments in general wards. The purpose of this report is to evaluate the experience of an antimicrobial stewardship programme in an intensive care unit (ICU). DesignProspective interventional, before-and-after study. Scope24-bed medical ICU in a tertiary hospital. InterventionProspective audit and feedback antimicrobial stewardship programme. EndpointsAntimicrobial consumption, antimicrobial related costs, multi-drug resistant microorganisms (MDRM) prevalence, nosocomial infections incidence, ICU length of stay, and ICU mortality rates were compared before and after one-year intervention. ResultsA total of 218 antimicrobial episodes of 182 patients were evaluated in 61 team meetings. Antimicrobial stewardship suggestions were accepted in 91.5% of the cases. Total antimicrobial DDD/100 patient-days consumption was reduced from 380.6 to 295.2 (-22.4%; p=0.037). Antimicrobial stewardship programme was associated with a significant decrease in the prescription of penicillins plus b-lactamase inhibitors, linezolid, cephalosporins, and aminoglycosides. Overall antimicrobial spending was reduced by €119,636. MDRM isolation and nosocomial infections per 100 patient-days did not change after the intervention period. No changes in length of stay or mortality rate were observed. ConclusionsAn ICU antimicrobial stewardship programme significantly reduced antimicrobial use without affecting inpatient mortality and length of stay. Our results further support the implementation of an antimicrobial stewardship programme in critical care units.

Pathoanatomical diagnosis, treatment and preventive measures at pigs gastroenterocolitis

The reasons of the occurrence of gastroenterocolitis of pigs, their pathomorphological manifestations are being discussed, the schemes of treatment and prophylaxis are offered. The most common factor-related infections in pig breeding are colibacillosis, dysentery and ileitis (proliferative enteropathy). Colibacteriosis occurs from birth to 50–60-day age, and dysentery with ileitis - from 2 to 5–6 months. It was established that the development of gastroenterocolitis is associated with a violation of the balance of the microflora and the reproduction of pathogenic strains of microorganisms, which can lead to the development of colibacteriosis, dysentery and ilite, sometimes – clostridiosis. In the pathoanatomical picture of colibacteriosis erosive gastroenteritis predominates, for dysentery – hemorrhagic colitis, for ileitis – proliferative ilite and colitis, for clostridios – hemorrhagic-necrotic enterocolitis. The analysis of veterinary measures carried out on farms showed a lack of a systematic approach to the treatment of factor infections. This was especially true for small farms, which attracted attention to the limited range of antibiotics, incorrect dosage of drugs, chaotic use of antimicrobial treatments. Experimental authors have compiled a universal preventive scheme for subspigmented piglets and breeding animals of the group that contained measures against gastroenterocolitiss of different etiologies. The work emphasizes the general prevention of diseases of the digestive system: providing animals with balanced quality feeds, improving the conditions for keeping pigs and conducting adequate medical and preventive measures.

Antimicrobial stewardship programme in critical care medicine: A prospective interventional study

ObjectiveHospital antimicrobial stewardship programmes have achieved savings and a more rational use of antimicrobial treatments in general wards. The purpose of this report is to evaluate the experience of an antimicrobial stewardship programme in an intensive care unit (ICU). DesignProspective interventional, before-and-after study. Scope24-bed medical ICU in a tertiary hospital. InterventionProspective audit and feedback antimicrobial stewardship programme. EndpointsAntimicrobial consumption, antimicrobial related costs, multi-drug resistant microorganisms (MDRM) prevalence, nosocomial infections incidence, ICU length of stay, and ICU mortality rates were compared before and after one-year intervention. ResultsA total of 218 antimicrobial episodes of 182 patients were evaluated in 61 team meetings. Antimicrobial stewardship suggestions were accepted in 91.5% of the cases. Total antimicrobial DDD/100 patient-days consumption was reduced from 380.6 to 295.2 (−22.4%; p=0.037). Antimicrobial stewardship programme was associated with a significant decrease in the prescription of penicillins plus b-lactamase inhibitors, linezolid, cephalosporins, and aminoglycosides. Overall antimicrobial spending was reduced by €119,636. MDRM isolation and nosocomial infections per 100 patient-days did not change after the intervention period. No changes in length of stay or mortality rate were observed. ConclusionsAn ICU antimicrobial stewardship programme significantly reduced antimicrobial use without affecting inpatient mortality and length of stay. Our results further support the implementation of an antimicrobial stewardship programme in critical care units.

Antimicrobial Resistance and Stewardship in National Action Plans

Tackling Antimicrobial resistance has global focus due to the significant threat resistance poses to human and animal health and its potential impact on the global economy as a result of reduced productivity caused by sickness and higher treatment costs. Therefore, the importance of strengthening health systems ensuring antimicrobial agents are used and accessed appropriately has never been more important. A potential solution to combating antimicrobial resistance globally is implementing comprehensive and sustainably resourced national plans based on a multi-sector approach. In May 2014, the World Health Organisation passed a resolution that reflects global agreement on the huge threat antimicrobial resistance poses to human health; this was followed by publication of a draft global action plan on which all national action plans being developed are expected to be based. The global action plan seeks to preserve and maintain the responsible and accessible use of antimicrobials for all. The main strategic objectives focus on improving the understanding and awareness of antimicrobial resistance, strengthening knowledge via research and surveillance, reducing infection incidence, optimising the use of antimicrobial treatments and countering antimicrobial resistance through sustainable investment. This paper seeks to explore the global adoption and implementation of national action plans and specifically the use of antimicrobial stewardship (AMS) strategies to promote the optimal use of antimicrobials.

Challenges and Opportunities for Typhoid Fever Control: A Call for Coordinated Action.

The burden of enteric fever caused by Salmonella enterica serovars Typhi and Paratyphi is substantial and has high impact in toddlers and young children. This burden is relatively well documented in Asia, and this supplement provides new data on the substantial burden in several sub-Saharan African countries. Challenges in standardized surveillance and imperfect diagnostic tools have resulted in patchy local disease data, which are not well acknowledged or integrated into local country evidence and health awareness for decision making. There is a need to strengthen diagnostics for the generation of burden data in country. Furthermore, the guidelines and training for treatment of enteric fever cases in Africa are sorely needed to help mitigate the inappropriate use of antimicrobial treatment. Classic water safety and access to sanitation development remain powerful tools for the control of typhoid fever, yet the huge economic costs and long timelines are unlikely to provide a short- to middle-term solution. Emerging threats, including multidrug resistance and increasing urbanization in regions such as sub-Saharan Africa, warrant focused attention to shorter-term interventions including immunization, and must include vaccine strategies with the new typhoid conjugate vaccines.